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====== Anemia ====== | ====== Anemia ====== | ||
- | < | + | < |
- | Anemia of chronic disease, also referred to as anemia of inflammatory response, is a common condition seen in chronic illness.(({{pubmed> | + | Anemia of chronic disease, also referred to as anemia of inflammatory response, is a common condition seen in chronic illness.(({{pmid> |
Standard measures of iron status, such as ferritin, total iron-binding capacity, and serum iron are directly affected by chronic disease. In contrast, soluble transferrin receptor (sTfR) is elevated in iron deficiency but is not appreciably affected by chronic disease. | Standard measures of iron status, such as ferritin, total iron-binding capacity, and serum iron are directly affected by chronic disease. In contrast, soluble transferrin receptor (sTfR) is elevated in iron deficiency but is not appreciably affected by chronic disease. | ||
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- | //**Eugene D. Weinberg**, "Iron Withholding: | + | //**Eugene D. Weinberg**, "Iron Withholding: |
- | The low levels of blood cells characteristic of anemia of chronic disease (ACD) are relatively common among autoimmune conditions(({{pubmed> | + | The low levels of blood cells characteristic of anemia of chronic disease (ACD) are relatively common among autoimmune conditions(({{pmid> |
- | However, Zarychanski and Houston state ACD is fundamentally an adaptive physiologic response which benefits the patient during times of infection(({{pubmed> | + | However, Zarychanski and Houston state ACD is fundamentally an adaptive physiologic response which benefits the patient during times of infection(({{pmid> |
- | Further, the ability of a particular species of bacteria to glean iron from its host is often a good indicator of its virulence. It is logical then that the body sequesters iron in response to an infection: Kemna et al. showed that injecting human volunteers with lipopolysaccharides, | + | Further, the ability of a particular species of bacteria to glean iron from its host is often a good indicator of its virulence. It is logical then that the body sequesters iron in response to an infection: Kemna et al. showed that injecting human volunteers with lipopolysaccharides, |
It might otherwise seem reasonable for a clinician to directly manage ACD using iron supplements or other antianemic therapies: fatigue and shortness of breath can be very unpleasant. However, administering this type of short-time palliation may lead to poorer outcomes. The possibility that ACD is an adaptive response by the host to microbes raises the specter that artificially resolving anemia subverts the immune response allowing microbes to spread by subverting the immune response and consequently allowing microbial infections to proliferate, | It might otherwise seem reasonable for a clinician to directly manage ACD using iron supplements or other antianemic therapies: fatigue and shortness of breath can be very unpleasant. However, administering this type of short-time palliation may lead to poorer outcomes. The possibility that ACD is an adaptive response by the host to microbes raises the specter that artificially resolving anemia subverts the immune response allowing microbes to spread by subverting the immune response and consequently allowing microbial infections to proliferate, | ||
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===== Tests ===== | ===== Tests ===== | ||
- | * **serum ferritin** – The protein in the blood that stores iron for later use by the body. Serum ferritin is also an acute phase reactant and will rise rapidly in the face of inflammation. May be high in anemia of chronic disease, especially if the liver is involved. Macrophages, | + | * **serum ferritin** – The protein in the blood that stores iron for later use by the body. Serum ferritin is also an acute phase reactant and will rise rapidly in the face of inflammation. May be high in anemia of chronic disease, especially if the liver is involved. Macrophages, |
- | * **serum iron** – The amount of iron being carried by transferrin in the blood plasma. On its own, serum iron provides no useful information. Serum iron has a diurnal variation that can be as much as 30% within a single individual. It is sensitive to the day's dietary iron intake and is affected by all the confounding diseases listed above. A low serum iron picked up as an incidental finding has a very low specificity for iron deficiency. Described further [[http:// | + | * **serum iron** – The amount of iron being carried by transferrin in the blood plasma. On its own, serum iron provides no useful information. Serum iron has a diurnal variation that can be as much as 30% within a single individual. It is sensitive to the day's dietary iron intake and is affected by all the confounding diseases listed above. A low serum iron picked up as an incidental finding has a very low specificity for iron deficiency. Described further [[https:// |
- | * **total iron binding capacity (TIBC)** – Shows if there is the "right amount" | + | * **total iron binding capacity (TIBC)** – Shows if there is the "right amount" |
* **soluble transferrin receptor (sTfR)** – Relatively new test. While standard measures of iron status such as ferritin, total iron-binding capacity, and serum iron are directly affected by chronic disease sTfR is elevated in iron deficiency but is not appreciably affected by chronic disease. A good way to verify anemia of chronic desease because it is not affected by inflammation. Should be considered for anemic patients whose differential diagnosis includes iron deficiency and anemia of inflammatory disease. | * **soluble transferrin receptor (sTfR)** – Relatively new test. While standard measures of iron status such as ferritin, total iron-binding capacity, and serum iron are directly affected by chronic disease sTfR is elevated in iron deficiency but is not appreciably affected by chronic disease. A good way to verify anemia of chronic desease because it is not affected by inflammation. Should be considered for anemic patients whose differential diagnosis includes iron deficiency and anemia of inflammatory disease. | ||
* **hemoglobin | * **hemoglobin | ||
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Doctors using these drugs are advised "to maintain the lowest hemoglobin level consistent with avoiding the need for transfusions." | Doctors using these drugs are advised "to maintain the lowest hemoglobin level consistent with avoiding the need for transfusions." | ||
- | A randomized controlled trial of critically ill patients showed erythropoiesis-stimulating agents did not reduce overall mortality.(({{pubmed> | + | A randomized controlled trial of critically ill patients showed erythropoiesis-stimulating agents did not reduce overall mortality.(({{pmid> |
===== Epidemiological studies ===== | ===== Epidemiological studies ===== | ||
- | In a 10 year follow up study from Chile, infants who already had high levels of hemoglobin proteins in their blood and were fed iron-fortified formula [[http:// | + | In a 10 year follow up study from Chile, infants who already had high levels of hemoglobin proteins in their blood and were fed iron-fortified formula [[https:// |
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{{tag> | {{tag> | ||
+ | < | ||
===== Notes and comments ===== | ===== Notes and comments ===== | ||
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* Legacy content | * Legacy content | ||
- | * [[http:// | + | * [[https:// |
- | * [[http:// | + | * [[https:// |
Given iron’s role as a key microbial nutrient, it may be that patients receiving blood plasma have significantly increased mortality as was reported in a randomized controlled trial(9971864) and why an | Given iron’s role as a key microbial nutrient, it may be that patients receiving blood plasma have significantly increased mortality as was reported in a randomized controlled trial(9971864) and why an | ||
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- | According to the textbook "An Introduction to Human Disease: Pathology and Pathophysiology Correlations" | + | According to the textbook "An Introduction to Human Disease: Pathology and Pathophysiology Correlations" |
GI bleeding | GI bleeding | ||
- | A simple outpatient two minute check of your stool for blood would rule out your doctor' | + | A simple outpatient two minute check of your stool for blood would rule out your doctor' |
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Lowering olmesartan might improve the RBC levels but at the cost increasing the anoxia and and impeding the healing in the kidneys. | Lowering olmesartan might improve the RBC levels but at the cost increasing the anoxia and and impeding the healing in the kidneys. | ||
- | for reference links, see full [[http:// | + | for reference links, see full [[https:// |
- | ===== References ===== | + | ===== References =====</ |